Eye on Healthcare: Another type of ACE

Wednesday

Mar 7, 2018 at 12:41 PMMar 7, 2018 at 12:43 PM

One of the most consistent findings, and yet one of the most perplexing, is that people who are of lower social and economic classes are not as healthy, nor do they live as long as those in the middle and upper classes.

Bradly Bundrant, MD, MPH

One of the most consistent findings, and yet one of the most perplexing, is that people who are of lower social and economic classes are not as healthy, nor do they live as long as those in the middle and upper classes. This is true even when we take into account all of the things we know to be important, such as nutrition, sleep, smoking and injuries — but why?

The first big piece of the puzzle came to light in 1998 with the publishing of a study of thousands of people in the Kaiser HMO who answered questions about their experiences growing up and about their health or illnesses as adults. They were asked about abuse they experienced before they were 18 years old, using questions to uncover psychological, physical and sexual abuse. People were also asked questions aimed at four other categories: living with someone who used street drugs or abused alcohol, living with someone who was mentally ill, living in a home where the mother was treated violently and living in a home where a household member went to prison.

These three categories of abuse and four categories of dysfunction are known as Adverse Childhood Experiences (ACEs). They turn out to be highly predictive of disease, disability and early death for those individuals who were exposed to 4 categories or more. In the study there were 3,859 people who reported no exposure in any category, 2,009 respondents had one, 1,050 people reported two and 590 reported exposures to 3 categories but these were not statistically different in terms of their likelihood of having cancer or heart attack or chronic bronchitis/COPD. However, the 545 people who had exposures to four or more categories were more than twice as likely to have a heart attack, twice as likely to have cancer and four times as likely to have chronic lung disease as those who had no ACE.

These abusive and dysfunctional situations may be many things, but they are always stressful. While stress is not always bad, stress that is of high intensity or long duration is toxic stress, and under these conditions the body produces hormones and neurotransmitters that have evolved to help humans live through stressful periods such as famines. According to one expert:

The result of this extended stress response is that a child’s nervous system, immune system and even DNA are changed. Toxic stress causes the fear centers of the brain (limbic system, amygdala) to significantly increase in size, and the child can develop symptoms very similar to post-traumatic stress disorder (PTSD). Toxic stress decreases the size and impairs the functioning of the regions of the brain responsible for learning, memory, executive functioning (prefrontal cortex, hippocampus). As a result, the child is placed at risk for having learning and behavior problems. The child’s immune system is suppressed and puts the child at risk for developing a variety of chronic, lifelong health conditions including asthma, heart disease, stroke, autoimmune disease and cancer. The DNA is changed in such a way that the child’s gene expression affects bodily functions and can potentially be passed on to the next generation.

Evidently poor heath is associated with low economic class because both are caused by the same thing. Exposure to four or more ACEs leads to both poor health and poor cognitive skills, which in turn results in low earning capacity. Next week we will look at what can be done, remembering…

“It is easier to build strong children than to repair broken men.”— Frederick Douglass

Bradly Bundrant, MD, MPH is the chief of staff of Ballinger Memorial Hospital. The Health and Wellness Coalition of Runnels County will meet today March 8 in the conference room adjacent to Keel Drug to discuss emergency preparedness, planning and coordination in Runnels County.